||Background Information on the Global Themes
is a state of complete physical, mental and social well-being,
and not merely the absence of disease or infirmity."
Health is a social, economic
and political issue as well as an issue concerning human rights.
Inequality and poverty lie at the root of ill health, as well
as the deaths of poor and marginalised people. The World Health
Report classifies sicknesses and causes of death with number codes.
The first cause of death around the world, according to the World
Health Report, is that corresponding to number 259.5: extreme
poverty. It has become a vicious circle: poverty causes illness,
which in turn leads to greater poverty.
In recent decades, economic changes worldwide have profoundly
affected people's health and their access to health care and social
services. World resources are increasingly concentrated in the
hands of a few economic players who strive to maximise their private
profits. Economic and financial policy is increasingly made by
a small group of governments and international bodies, such as
the World Bank, the International Monetary Fund and the World
Trade Organisation. The policies of these organisations, together
with the activities of multinational companies, have severe effects
on the lives, livelihoods, health and well-being of people in
both the Southern and the Northern hemispheres.
As never before, the figures of deaths and illnesses have the
face of injustice and inequality: 75% of the world population
live in developing countries and represent only 8% of the world's
pharmaceutical market. Furthermore, one third of the world population
has no access at all to essential drugs.
Aids and human rights
A paradigmatic example is Aids.
While in rich countries, people who have HIV/Aids can live better
and longer because of anti-retroviral drugs, which are provided
by some states for free or at reasonable prices, in southern countries
people affected by HIV die because they have no access to treatment.
In most cases, the annual per-capita expenses in health amount
to about US$10.
The United Nations Commission on Human Rights in a report issued
on Aids and human rights has identified the following human rights,
among others, as tightly linked to the spread of Aids all over
- The right to marry and found a family. A report by the UN
Commission on Human Rights states that "it is clear that
the right of people living with HIV/Aids is infringed by mandatory
pre-marital testing and/or the requirement of "Aids-free
certificates" as a precondition for the grant of marriage
licences under state laws. Secondly, forced abortions or sterilisation
of women living with HIV violates the human right to found a
family, as well the right to liberty and integrity of the person."
- The human rights of children and young people may also be
under threat. "Many of these rights, such as freedom from
trafficking, prostitution, sexual exploitation and sexual abuse,
are relevant to HIV/Aids prevention, care and support for children,
since sexual violence against children, among other things,
increases their vulnerability to HIV/Aids. The freedom to seek,
receive and impart information and ideas of all kinds and the
right to education both provide children with the right to give
and receive all the HIV-related information they need to avoid
infection and to cope with their status if infected."
- "The right to privacy covers obligations to respect
physical privacy, including the obligation to seek informed
consent to HIV testing, and also privacy of information, including
the need to respect confidentiality of all information relating
to a person's HIV status. The individual's interest in his/her
privacy is particularly compelling in the context of HIV/Aids,
firstly because of the invasive character of a mandatory HIV
test, and secondly because of the stigma and discrimination
attached to the loss of privacy and confidentiality, if HIV
status is disclosed. The community has an interest in maintaining
privacy so that people will feel safe and comfortable in using
public health measures."
- The right to education: "This right includes three broad
components which apply in the context of HIV/Aids. Firstly,
both children and adults have the right to receive HIV-related
education, particularly regarding prevention and care. Access
to education concerning HIV/Aids is an essential life-saving
component of effective prevention and care programmes. It is
the state's obligation to ensure, in every cultural and religious
tradition, that appropriate means are found so that effective
HIV/Aids information is included in educational programmes inside
and outside schools. Secondly, states should ensure that both
children and adults living with HIV/Aids are not discriminated
against by being denied access to education, including access
to schools, universities, scholarships and international education
or subjected to restrictions because of their HIV status. There
is no public health rationale for such measures since there
is no risk of transmitting HIV casually in educational settings.
Thirdly, states should, through education, promote understanding,
respect, tolerance and non-discrimination in relation to persons
living with HIV/Aids."
- "The right to work entails the right of every person
to access to employment without any precondition except the
necessary occupational qualifications. This right is violated
when an applicant or employee is required to undergo mandatory
testing for HIV and is refused employment or dismissed or refused
access to employee benefits on the grounds of a positive result."
In which way do people in your country who suffer from Aids or
are HIV positive see their rights violated? How can it be avoided?
|Health and environment
Some health issues are also
linked to environmental problems. In October 2001, a conference
was organised to analyse the consequences on health of climate
change and ozone depletion. Experts in the field believe
that "the potentially damaging impacts of the interaction
between climate change and ozone depletion are very significant"
and that "urgent action is required to reduce both
environmental damage and its impact on health".32
Health and youth
In recent years, a worrying trend in many European Member States
has been the rise in the consumption of alcohol by young people
at increasingly younger ages. The harm they experience as a result
is considerable. A comparative risk analysis shows, for instance,
that one in four deaths in males aged 15-29 years in the European
region is attributable to alcohol. These considerations led to
the decision to make "Young people and alcohol" the
theme of the WHO Ministerial Conference (Stockholm, 19-21 February
2001), and the overall goal of the conference was to boost implementation
of the European Alcohol Action Plan.
The conference adopted a declaration containing the following
- identification of alcohol as an important issue in young
- confirmation of the need to have public health/alcohol policy
developed, without any interference from commercial or economic
- the opportunity to have young people themselves involved
in the policy-making process;
- the need to determine targets, at national and local levels,
to reduce the impact of alcohol on young people's health.
Several steps were recommended for approval by the Regional Committee
for Europe of the World Health Organisation. These included:
- strengthening international partnerships, especially with
the European Commission, the Council of Europe, the United Nations
Children's Fund and the European Forum of Medical Associations
and World Health Organisation (WHO);
- maintenance of contact with young people and their organisations
throughout the region;
- the establishment of a system for monitoring the promotion
of alcoholic beverages to young people.
Can you make a list of concrete and practical actions that could
be developed to help implement these recommendations in your own
community and country?
As is emphasised in the above recommendations, young people
can and should be strategic partners in activities or programmes
that deal with health problems, either through prevention or intervention.
There are youth organisations that are active in this field of
health, such as the International Federation of Red Cross and
Red Crescent Societies, which have youth sections all over the
world. The European Network of Health Promoting Schools is a tripartite
project launched by the World Health Organisation Regional Office
for Europe, the European Commission and the Council of Europe.
It emphasises the importance of health promotion in the education
system by means of collaboration between health and education
professionals and members of the community.
The right to health
The right to health is mentioned in several international human
rights instruments such as in Article 12 of the International
Covenant on Economic, Social and Cultural Rights, and Article
24 of the Convention on the Rights of the Child. As far as Europe
is concerned, Article 13 of the European Social Charter refers
to it extensively:
"With a view to ensuring the effective exercise of the
right to social and medical assistance, the Contracting Parties
- To ensure that any person who is without adequate resources
and who is unable to secure such resources either by his own
efforts or from other sources, in particular by benefits under
a social security scheme, be granted adequate assistance, and,
in case of sickness, the care necessitated by this condition;
- To ensure that persons receiving such assistance shall not,
for that reason, suffer from a diminution of their political
or social rights;
- To provide that everyone may receive by appropriate public
or private services such advice and personal help as may be
required to prevent, to remove, or to alleviate personal or
- To apply the provisions referred to in paragraphs 1, 2 and
3 of this Article on an equal footing with their nationals to
nationals of other Contracting Parties lawfully within their
territories, in accordance with their obligations under the
European Convention on Social and Medical Assistance, signed
at Paris on 11th, December 1953."
The 1999 World Health Report identified the following four main
challenges for national governments, the international community,
and civil society:
- directing health systems towards delivering a minimum number
of interventions, which would have the greatest impact in reducing
the excessive disease burden suffered by the poor. This includes
a renewed commitment to malaria control, extended efforts to
control tuberculosis, a focus on maternal and child health and
nutrition, and the revitalisation and extended coverage of immunisation
- enabling health systems to counter proactively the potential
threats to health resulting from economic crises, unhealthy
environments or risky behaviour. One of the most important threats
is tobacco addiction. A global commitment to tobacco control
could avert millions of premature deaths. Other priorities include
combating the spread of resistance to anti-microbials and mounting
an effective response to the threat of emerging diseases. Also
critical are the global eradication of polio and the promotion
of healthy lifestyles (including cleaner air and water, adequate
sanitation, healthy diets and safer transportation).
- developing health systems that provide universal access to
clinical services with no fees (or only small fees) at the point
of delivery. This will require public finance, government-mandated
social insurance, or both. However, it is recognised that if
services are to be provided for all, then not all services can
be provided. The most cost-effective services should be provided
first. Even the wealthiest countries cannot provide entire populations
with every intervention where the medical value outweighs the
- encouraging health systems to invest in expanding the knowledge
base that made the twentieth-century revolution in health possible
and that will provide the tools for continued gains in the twenty
first century. The most critical need is for research and development
on infectious diseases that disproportionately affect the poor
and the establishment of an information base to help countries
develop their own health systems.